Pain Physician Salaries?

[alocketz]

you are misleading the readers of this forum.....700k is not the starting salary for pain management....there are very few pain management practitioners who are making that kind of money.....i am in private practice myself .....MGMA which is very reputable quotes average pain management salaries in the 300's.........500k is the 90th percentile........your figures are misleading and just downright wrong[/QUOTE]



Can Anyone post the MGMA data from 2005? I see the 2006 data is not available until September. I went to their site but you have to pay hundreds of dollars to get the info? Salary.com and Allied Physicians Physician Salary Survey both had similar data but I would like a copy of the MGMA data for an upcoming negotiation.

Thanks!

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[nodolormd]

I've been reading these posts with some amusement off and on for a year or so and couldn't resist speaking up. I am a full time practicing pain MD with ABA boards in Anesthesiology and Pain and a full year(plus) of fellowship training. I've been in practice for a decade.

First, let me inject a little reality into the salary questions. There are some incredibly high starting salaries in this specialty. They are in the 300K-400K range. Check out gaswork.com for a current set of listings.

What you will actually earn in the first year will likely be far less than 300K unless you are subsidized heavily. It takes about 3 years to build a busy single doctor practice in most markets. If you are subsidized, you can expect that to be contingent on a number of things such as taking anesthesia call, doing high volumes of procedures in someone elses facility where they get the facility fee, or by being the only guy around for a hospital. Most of these lucrative deals are in less desirable areas or are offered by very busy physicians who own facilities(where the real money is) and you will be burning your hands off under a fluoroscope all day every day to make that money.(much of what you do will be unnecessary and if you have any concience, you should be concerned about the ethics of it all). Be sure you understand, you will be making far more for the guy who hires you than you will for yourself Nobody gets a free ride. The money is usually pulled after a year or two and you are on an "eat what you kill" system. You may very well see your income fall at this point and you will have to spend the three years or so it takes to actually build up a solid practice. You will also have a mercedes and a nice home and be leveraged to the eyeballs at that point and have a tough time keeping up.

If you set up your own practice, you will spend around 150K to build it and staff it in the first year and you might generate 150K in the first year in revenues. The second year should about double and the third will level off around 400K. It will stay there unless you invest in some sort of a facility where you can capture facility fees. The really big money comes from running a business and hiring others to work for you(MD's, PA's, CRNA's) and collecting a percentage of what they earn. Nobody makes over a million by just practicing medicine. You could do just as well and probably better by running any other company with personell who do the work to make the money. In medical practice, there is high liability, high insurance, expensive employees and high overhead that can be avoided in another business. Those of us who do make alot of money don't do it seeing patients. We do it by investing in and building other businesses and by having a large number of employees who work hard for us.

My advice would be to choose a specialty you like and enjoy your work. Don't just go after money. If you want to make alot of money, go into Investment Banking or Private Equity. It'll take less time and you can cash out with 40 mil in bonus when you are 36.

I was having a conversation with an old colleague of mine in Dallas about 6 months ago. He was used to making around 1 mil per year, but had a drop in revenues due to a number of misadventures in his practice. He was really upset when he told me his income had dropped below 600K for 2006. "It isn't worth doing for less than a million dollars" he said to me. Do you really want your practice to make you feel like that?

 

[Aether2000]

The 300-400K mark seems about right, but it depends heavily on payor class mix, penchant to do injections instead of seeing patients in followup, and whether you add the more advanced but less pay per hour procedures (pumps, stims, endo spine, etc). The style of practice that would produce 1 mil in after expenses income would not permit me to sleep at night.

 

[lobelsteve]

The 300-400K mark seems about right, but it depends heavily on payor class mix, penchant to do injections instead of seeing patients in followup, and whether you add the more advanced but less pay per hour procedures (pumps, stims, endo spine, etc). The style of practice that would produce 1 mil in after expenses income would not permit me to sleep at night.

Would that be due to conscience or volume of procedures that you would need to be up all night doing?

 

[Aether2000]

Primarily my conscience....
With an enormous volume of blocks, the physician is reduced to a sub-physician technician level, that effectively creates a one trick pony scenerio. I like to offer lots of tricks (medically speaking of course)....

 

[Spine Specialist]

I've been reading these posts with some amusement off and on for a year or so and couldn't resist speaking up. I am a full time practicing pain MD with ABA boards in Anesthesiology and Pain and a full year(plus) of fellowship training. I've been in practice for a decade.

First, let me inject a little reality into the salary questions. There are some incredibly high starting salaries in this specialty. They are in the 300K-400K range. Check out gaswork.com for a current set of listings.

What you will actually earn in the first year will likely be far less than 300K unless you are subsidized heavily. It takes about 3 years to build a busy single doctor practice in most markets. If you are subsidized, you can expect that to be contingent on a number of things such as taking anesthesia call, doing high volumes of procedures in someone elses facility where they get the facility fee, or by being the only guy around for a hospital. Most of these lucrative deals are in less desirable areas or are offered by very busy physicians who own facilities(where the real money is) and you will be burning your hands off under a fluoroscope all day every day to make that money.(much of what you do will be unnecessary and if you have any concience, you should be concerned about the ethics of it all). Be sure you understand, you will be making far more for the guy who hires you than you will for yourself Nobody gets a free ride. The money is usually pulled after a year or two and you are on an "eat what you kill" system. You may very well see your income fall at this point and you will have to spend the three years or so it takes to actually build up a solid practice. You will also have a mercedes and a nice home and be leveraged to the eyeballs at that point and have a tough time keeping up.

If you set up your own practice, you will spend around 150K to build it and staff it in the first year and you might generate 150K in the first year in revenues. The second year should about double and the third will level off around 400K. It will stay there unless you invest in some sort of a facility where you can capture facility fees. The really big money comes from running a business and hiring others to work for you(MD's, PA's, CRNA's) and collecting a percentage of what they earn. Nobody makes over a million by just practicing medicine. You could do just as well and probably better by running any other company with personell who do the work to make the money. In medical practice, there is high liability, high insurance, expensive employees and high overhead that can be avoided in another business. Those of us who do make alot of money don't do it seeing patients. We do it by investing in and building other businesses and by having a large number of employees who work hard for us.

My advice would be to choose a specialty you like and enjoy your work. Don't just go after money. If you want to make alot of money, go into Investment Banking or Private Equity. It'll take less time and you can cash out with 40 mil in bonus when you are 36.

I was having a conversation with an old colleague of mine in Dallas about 6 months ago. He was used to making around 1 mil per year, but had a drop in revenues due to a number of misadventures in his practice. He was really upset when he told me his income had dropped below 600K for 2006. "It isn't worth doing for less than a million dollars" he said to me. Do you really want your practice to make you feel like that?

Thank you for sharing your thoughts. Please keep posting.

 

[nodolormd]

The fun part of pain, particularly for an Anesthesiologist like me is two fold. First, I'm in charge of my own destiny again. No more fighting with the surgeon about bringing a pyloric stenosis infant to the OR without correcting electrolytes, etc. The second is that you actually get to spend time with patients again. They will buy you x-mas gifts and send you thank you letters for your efforts. I rarely get complaints about billing and I rarely get calls after hours.
Don't get too hung up on the money. You will be fairly compensated for what you do as long as you have a varied payor mix and varied practice. Intervention has its place, but not exclusively in this specialty. I have a very busy practice. I have 9-yes nine-spine surgeons in my area who refer to me and I still only do procedures about 25% of the time. The rest is E&M's. Do a good job and you will be busy and wealthy enough to get most of what you want. Then be sure you live your life too. You never know when you might get run over by a truck.

 

[Mister Mxyzptlk]

"Do well by doing good."

 

[Tenesma]

i think the reality is clearly underlined by nodolormd...

there is money in procedures - but the more you do, the more risk, the more radiation and the less time you can spend properly evaluating your patients.

i have been toying with the idea of using an NP/PA but am afraid that I am going to miss things if I rely on them... plus what is the math behind how many patients they need to see before I can generate income from them???

plus how do i not offend patients and referring physicians if PAs/NPs are doing my work???

what is the most cost-effective and clinically relevant of using a mid-level?

i have a friend who uses RNs because they aren't as independent-minded, and they are cheaper... anybody w/ experience on these issues?

 

[Ligament]

I've spent time in pain practices with mid-levels. In my opinion they are fine and useful for stable patients coming in for follow-ups, especially for a simple monthly opioid refill. Also very useful for pump refills. If you have a very large practice this will take a lot of time off your hands. However I would never want them to do initial consults for my practice; heck, most pain docs have no idea what they are doing on consults!

I cannot comment on your other questions.

i think the reality is clearly underlined by nodolormd...

there is money in procedures - but the more you do, the more risk, the more radiation and the less time you can spend properly evaluating your patients.

i have been toying with the idea of using an NP/PA but am afraid that I am going to miss things if I rely on them... plus what is the math behind how many patients they need to see before I can generate income from them???

plus how do i not offend patients and referring physicians if PAs/NPs are doing my work???

what is the most cost-effective and clinically relevant of using a mid-level?

i have a friend who uses RNs because they aren't as independent-minded, and they are cheaper... anybody w/ experience on these issues?

 

[Aether2000]

We have a NP in our office performing pump refills, seeing follow-up patients, seeing add on follow-up patients, and calling patient's when they leave clinical message issues. She is in contact with me virtually all the time via interoffice emails through the EMR or telephone when I am off site. She sometimes has patients in the office and will type me a quick note or question about the patient, or come out and speak to me about a complex situation. For those situations that are too complex, she reschedules the patients to see me, or I will quickly evaluate the patient in her office.
Typically she sees about 26 patients a day, and that amount will generate a profit for the clinic that is not inconsequential. The breakpoint for salary and benefits is around 15 a day, but that number depends on patient class mix, charge level, efficiency of the NP, and the actual salary/benefits.
The NP does TPI and tendon/ligament injections and a few peripheral bursa injections. She can do seroma/abscess aspirations. The best thing about my NP is that she dogs the patients regarding narcotics, and does pill counts, UDS, and pharmacy calls to keep them honest. She has carte blanche to stop all narcotics in situations where there is abuse or diversion since she is viewed as a direct extension of my practice. Patients very much enjoy her thoroughness with them but also understand that our predefined clinic policies regarding narcotics are followed without exception by her.

PAs are also very useful, and many surgeons use them for their initial consultation, but I am uncomfortable having any initial assessment done by anyone except myself, lest we wind up on the wrong path from the very start.

RNs may only capture a level I charge, so are not all that useful for a busy practice seing followups..

 

[lobelsteve]

I have worked with a PA in the past that was excellent, could see 30 patients a day, do all the pump refills with ease. He had no interestin doing fluoro guided procedures and did not hesitate to ask for help.

I also worked in a clinic where the PA insisted he was a better pain doc than I, he performed procedures under the supervision of another physician. I would not let him inject any of my patients, nor would I trust his work on a follow up or new eval.

It's a mixed bag out there- but it is ultimately your license.

 

[CristaGalli]

The fun part of pain, particularly for an Anesthesiologist like me is two fold. First, I'm in charge of my own destiny again. No more fighting with the surgeon about bringing a pyloric stenosis infant to the OR without correcting electrolytes, etc. The second is that you actually get to spend time with patients again. They will buy you x-mas gifts and send you thank you letters for your efforts. I rarely get complaints about billing and I rarely get calls after hours.
Don't get too hung up on the money. You will be fairly compensated for what you do as long as you have a varied payor mix and varied practice. Intervention has its place, but not exclusively in this specialty. I have a very busy practice. I have 9-yes nine-spine surgeons in my area who refer to me and I still only do procedures about 25% of the time. The rest is E&M's. Do a good job and you will be busy and wealthy enough to get most of what you want. Then be sure you live your life too. You never know when you might get run over by a truck.

Hello, I was wondering if you could comment on the job outlook (from salary, to reimbursements, to cRNA's stealing our jobs) for pain physicians, what a typical week is like for you or was like for you, and if you have adequate time to pursue other interests.
Thanks!

 

[freddydpt]

Do you guys know any IR docs in the pain field? I know they do epidurals, kyphoplasties, vertebroplasties, but do they do pain management?

 

[Ligament]

There is a guy named C. Aprill that does some stuff.

 

[ampaphb]

There is a guy named C. Aprill that does some stuff.

And D. Fenton

 

[Josh L.Ac.]

We have a NP in our office performing pump refills, seeing follow-up patients, seeing add on follow-up patients, and calling patient's when they leave clinical message issues. She is in contact with me virtually all the time via interoffice emails through the EMR or telephone when I am off site. She sometimes has patients in the office and will type me a quick note or question about the patient, or come out and speak to me about a complex situation. For those situations that are too complex, she reschedules the patients to see me, or I will quickly evaluate the patient in her office.
Typically she sees about 26 patients a day, and that amount will generate a profit for the clinic that is not inconsequential. The breakpoint for salary and benefits is around 15 a day, but that number depends on patient class mix, charge level, efficiency of the NP, and the actual salary/benefits.
The NP does TPI and tendon/ligament injections and a few peripheral bursa injections. She can do seroma/abscess aspirations. The best thing about my NP is that she dogs the patients regarding narcotics, and does pill counts, UDS, and pharmacy calls to keep them honest. She has carte blanche to stop all narcotics in situations where there is abuse or diversion since she is viewed as a direct extension of my practice. Patients very much enjoy her thoroughness with them but also understand that our predefined clinic policies regarding narcotics are followed without exception by her.

Sounds like the perfect job description [minus the lack of "dry needling", of course].

Do you think your use of a mid-level is an exception or reflection of the typical practice model, is there an obvious financial benefit to using her, and is she paid better than most of the "doctor's office NP's"?

Thanks.

 

[Aether2000]

I know of several practices using NPs for medication management issues. Incorporating proper oversight with pre-defined rules and parameters, NPs can make a valuable addition to the pain physician practice by expanding the practice scope of the corporation beyond that of needling.

 

[C Fiber]

Agreed. It's a very satisfying specialty for me for all the reasons you mentioned. What do you do for coverage? I have been working without a vacation for 1 year now. Last time I left for a conference for a few days and one of the referring doc got upset.

The fun part of pain, particularly for an Anesthesiologist like me is two fold. First, I'm in charge of my own destiny again. No more fighting with the surgeon about bringing a pyloric stenosis infant to the OR without correcting electrolytes, etc. The second is that you actually get to spend time with patients again. They will buy you x-mas gifts and send you thank you letters for your efforts. I rarely get complaints about billing and I rarely get calls after hours.
Don't get too hung up on the money. You will be fairly compensated for what you do as long as you have a varied payor mix and varied practice. Intervention has its place, but not exclusively in this specialty. I have a very busy practice. I have 9-yes nine-spine surgeons in my area who refer to me and I still only do procedures about 25% of the time. The rest is E&M's. Do a good job and you will be busy and wealthy enough to get most of what you want. Then be sure you live your life too. You never know when you might get run over by a truck.

 

[Tenesma]

c fiber

i feel your pain - i am in the same situation and am scratching my head...

choices
1) find another pain guy to cover call/practice for vacations
- problem is that there are no local pain guys, and the one that is here is useless

2) hire another doctor
- problem is that it means less money for me

3) ask local anesthesia group to do inpatient consultations for when i am on vacation
- they aren't too interested as i can't (don't want) to reciprocate - i don't want to do OR call in other words

4) notify all the local practices that I will be away for a week
- that solves the consultation problem but doesn't address the patient needs

5) hire an NP to take call for me and do inpatient consultations (and then run it by me via phone)...

these choices aren't great... any of the solo guys out there have any suggestions???

 

[PainDr]

I'm solo, but a hospital employee in a small town. We addressed this issue early on. There are no other pain physicians within a 50 mile radius and the anesthesiologists didn't want to cover, so this was our solution. We let it be known that I was willing to carry my pager/cell phone 24/7...even while on vacation. In return, we asked everyone to keep inpt consults and after hours calls to a minimum. So far, no one has abused the priviledge. When I'm out of town, the PCP's call me about inpt consults and we discuss the pts over the phone. My nurse fields outpt issues and we coordinate with the PCP to manage the problem until I get back. The key is developing good relationships with your PCPs and addressing the issue in a proactive way, so there are no surprises. Actually, before I came to town, they had no one at all, so having me available 24/7 is viewed as a real luxury. It may sound unreasonable to always be "on call", but it's not bad at all. I get after hours calls very infrequently, maybe 1-2 times per month and I usually don't get more than 2-3 inpt consults a month. When on vacation, I touch base with my nurse 2-3 times during the day, that way, unless it's an emergency, she doesn't have to call me everytime something comes up...she just makes a list and we address everything at my next check in. I think this works because it's a small tight knit community and everyone gets along pretty well. Also, when I'm going out of town, I'll arrange my schedule so that I leave at least several days after my last procedure day, so I'll still be around if a complication arises.

 

[PainMaster]

Maybe someone can help out an MSIV who is confused about Anesthesia vs. PMR. I know ultimately that I want to do pain medicine, what is the best route to go? Please don't be biased, I just want an honest answer.

Why aren't paindocs doing more vertebroplasty/kyphoplasty????

Whats the starting pain salary in NY?

Thanks

 

[PainDr]

Maybe someone can help out an MSIV who is confused about Anesthesia vs. PMR. I know ultimately that I want to do pain medicine, what is the best route to go? Please don't be biased, I just want an honest answer.

Whats the starting pain salary in NY?

Why aren't paindocs doing more vertebroplasty/kyphoplasty????

1) Some believe you'll be better trained if you choose PM&R, but we all know it's easier to get a fellowship from anesth. I recommend pursuing the specialty you find the most interesting. I was in the same boat as you and did ALOT of research as well as multiple electives. I found that I didn't really like either field and ended up choosing neurology. Was it harder to get a fellowship? Yes. Do I regret choosing the specialty I most enjoyed? No.

2) I have no idea. However, I suspect it's a pretty saturated region and therefore the salaries probably aren't that great. You'll need to do some research.

3) What makes you think we aren't doing vert/kypho?

 

[drusso]

Maybe someone can help out an MSIV who is confused about Anesthesia vs. PMR. I know ultimately that I want to do pain medicine, what is the best route to go? Please don't be biased, I just want an honest answer.

Why aren't paindocs doing more vertebroplasty/kyphoplasty????

Whats the starting pain salary in NY?

Thanks

Rotate in each of the "core" pain specialties---anesthesiology, physiatry, and neurology---and choose the one you like best. I've never met anyone who *REALLY* wanted to do pain, demonstrated it in their career development, jumped through all the right hoops, and did not get a fellowship...

 

[drugdealer3000]

I am a medical student that is applying for Anesthesia in the match this year. I am looking out five years to see what I want to do long term, cardiac anesthesia, pain management, etc.

I was wondering what the consensuses is currently as far as the best field to get into in regards to $$$.

Do you really have to be unethical to make $1 million in pain?

I am interested in going to a small town about 30,000 in size with no pain guys for 50 miles. Can I build a seven figure practice with this kind of setup? Is the government currently aggressively cutting compensation?

I can make $300K out of residency in anesthesia in a decent metro area. I like the work in OR anesthesia. If I do pain I would have to make a lot more to make up for the cost of employees, building, equipment, utilities, and tons of extra hours owning my own business. I like the idea of the technical skills in pain.

Do you think pain is dead? For all the hassle and being forced to live in a small town I wonder if pain will continue to pay enough to be worth it.

What are your thoughts.

 

[powermd]

I am a medical student that is applying for Anesthesia in the match this year. I am looking out five years to see what I want to do long term, cardiac anesthesia, pain management, etc.

I was wondering what the consensuses is currently as far as the best field to get into in regards to $$$.

Do you really have to be unethical to make $1 million in pain?

I am interested in going to a small town about 30,000 in size with no pain guys for 50 miles. Can I build a seven figure practice with this kind of setup? Is the government currently aggressively cutting compensation.

I can make $300K out of residency in anesthesia in a decent metro area. I like the work in OR anesthesia. If I do pain I would have to make a lot more to make up for the cost of employees, building, equipment, utilities, and tons of extra hours owning my own business. I like the idea of the technical skills in pain.

Do you think pain is dead? For all the hassle and being forced to live in a small town I wonder if pain will continue to pay enough to be worth it.

What are your thoughts.

 

[drugdealer3000]

.

 

[powermd]

Hhhhhmmm.... my first post on this forum. Lovely response from someone who claims to be a doctor. Is everyone as cerebral as powermd or is there intelligent life around here?

powermd do me an the rest of this forum a favor and go ph-k yourself!

Troll.

 

[drugdealer3000]

Troll.

Yes, of course... powermd, I happen not to like your unprovoked attack on me so that makes me a troll.

Please take your narcissism elsewhere. I want only intelligent answers to my query. I'm spending a lot of time and money putting a career together and I need info.

Wow, 1 post is all it takes to get a welcoming insult from powermd. Does he/she insult every new comer this way? What kind of doctors are they producing in US medical schools these days?

 

[OHMAN0125]

Yes, of course... powermd, I happen not to like your unprovoked attack on me so that makes me a troll.

Please take your narcissism elsewhere. I want only intelligent answers to my query. I'm spending a lot of time and money putting a career together and I need info.

Wow, 1 post is all it takes to get a welcoming insult from powermd. Does he/she insult every new comer this way? What kind of doctors are they producing in US medical schools these days?

Hmm....i dont have any hard evidence about the reimbursement for pain. But i've heard pain docs making 750k-1mill. I'm pretty sure it's more about their business model and auxillary services (ie. having a PT/OT department in ur pain center) that boost the income rather than the practice of "medicine".
I don't think pain is a dying field, they're prolly reimbursement cuts coming but what aspect of medicine doesnt have cuts looming?

 

[clubdeac]

I am a medical student that is applying for Anesthesia in the match this year. I am looking out five years to see what I want to do long term, cardiac anesthesia, pain management, etc.

I was wondering what the consensuses is currently as far as the best field to get into in regards to $$$.

Do you really have to be unethical to make $1 million in pain?

I am interested in going to a small town about 30,000 in size with no pain guys for 50 miles. Can I build a seven figure practice with this kind of setup? Is the government currently aggressively cutting compensation?

I can make $300K out of residency in anesthesia in a decent metro area. I like the work in OR anesthesia. If I do pain I would have to make a lot more to make up for the cost of employees, building, equipment, utilities, and tons of extra hours owning my own business. I like the idea of the technical skills in pain.

Do you think pain is dead? For all the hassle and being forced to live in a small town I wonder if pain will continue to pay enough to be worth it.

What are your thoughts.

Drugdealer3000, I think you got the barf icon because of the "tactful" way you posed your question . . . what's the best field to get into in regards to money. If that's why you went into medicine, then that's pretty sad. My answer for you is to take a 180 degree turn and become a venture capitalist or investment banker b/c you're gonna have to work WAY too hard in any medical field to bring in the kind of money those guys pull in their sleep. It's not too late to switch.

 

[drugdealer3000]

Drugdealer3000, I think you got the barf icon because of the "tactful" way you posed your question . . . what's the best field to get into in regards to money. If that's why you went into medicine, then that's pretty sad. My answer for you is to take a 180 degree turn and become a venture capitalist or investment banker b/c you're gonna have to work WAY too hard in any medical field to bring in the kind of money those guys pull in their sleep. It's not too late to switch.

clubdeac,

Sorry to disappoint. Wall St. doesn't work that way. I used to be a Wall Streeter! I'm actually quite content in medicine because I've seen what other jobs are like. I remember a banker buddy of mine staying at the office for 48 hrs straight working on a deal. Try weeks on end without a single day off. People in medicine would be crying about the 80 hr rule. I saw a grown man cry on the trading floor once. How many practicing surgeons have you seen cry? I got into medicine because I like the work better. Liking the job and wanting to make money are not mutually exclusive. I cannot for the life of me find where that is written anywhere in my medical textbooks.

I guess the difference between me and some people in medicine is I actually studied economics and finance in an academic institution and then had practical work in both fields so I know money motivates people. I'm comfortable with that. Its perfectly natural. Plus I find it interesting that no one gave me my degree, malpractice insurance, rent, electricity, etc for free. I've been tapped to the tune of a $250,000 and now people wanna barf when I ask about a little compensation? C'mon, man. Let's be adults here.

 

[drugdealer3000]

Hmm....i dont have any hard evidence about the reimbursement for pain. But i've heard pain docs making 750k-1mill. I'm pretty sure it's more about their business model and auxillary services (ie. having a PT/OT department in ur pain center) that boost the income rather than the practice of "medicine".
I don't think pain is a dying field, they're prolly reimbursement cuts coming but what aspect of medicine doesnt have cuts looming?

That's interesting. I just know its very difficult to work with other people. I've seen docs get associates and then have nasty fallings out. It seems to happen like clock work.

I dunno. If I could find some good people to work with I wouldn't mind trying to set up a comprehensive pain management center. I would like to do more of the technical stuff, but it would be good to get a psychiatrist, neurologist, physical therapist, ortho, neurosurgeon and so forth on board, but I find in small towns there are so many patients to go around and so much money that people are jerks... no customer service for pts or referring physicians.

I would definitely like to get back into the business side of things. I would enjoy setting up a comprehensive practice and really being the premier referral center for a community. I don't want to do the narcotic stuff, but you sorta need that to give complete pain management care. It would be nice to have someone do that stuff while I did the technical stuff and then maybe have a profit sharing arrangement.

I'm just throwing ideas out there.

I may just throw in the towel and just be an OR anesthesiologist and forget the whole business thing. OR anesthesia is pretty sweet. No office, no hassle. Do your thing in the OR and go home. Intervene, get immediate results and call it a day... not bad.

 

[drugdealer3000]

I've seen numerous job offers for OR anesthesia gigs that start off at $300K. I saw a pain management job offer for 500K.

It would seem to me if the first year you join a group in a major city they can hand you 500K then I really wonder what you can do on your own if you own the building. Sure you will have to build up your practice, but that's the point of going to a rural area with no competition.

I figure I could do half OR anesthesia and gradually build the pain stuff up. Is that not feasible? Once I get the volume, I get my own building, and cut back on the OR anesthesia.

 

[drugdealer3000]

.

 

[powermd]

DD3000,
Were you successful in your previous job? Retirement successful?

With your advanced understanding of economics I am surprised you would find 8+ years out of the work force making little to no money, and possibly going into significant debt, to be a "good deal". Unless you were an utter failure with no hope of ever making any "real" money in business.

If you don't care what you have to do to make the most money, why did you leave the business world? People who are very uncommonly successful in medicine might make a million a year. A small number of very saavy people combine business and medicine to market new products or services and make tens of millions, and even more. If you are talented enough to do that, you probably could have been much more successful, and sooner, with less risk, in your original job.

It disappoints me to see a medical student, who has no real knowledge of what it is to practice medicine, enter our forum and reduce what we have dedicated our lives to - helping ease the suffering of people in chronic pain - to how many bucks you can squeeze out before the party's over.

Medicine is a profession. That means our duty to our patients comes first. The image of pain medicine as a profession is currently suffering due to attitudes like your's among it's practitioners. It's hard to earn sympathy from congress people, who have influence over Medicare reimbursement rates, when our field continues to attract quick buck artists. Our integrity as professionals becomes suspect when we hint that money is a motivating factor in what we do.

You asked the question "Do you really have to be unethical to make $1 million in pain?" YOUR integrity is suspect.

Just curious, what has your experience been thus far in working with chronic pain patients? Do you have any?

 

[drugdealer3000]

.

 

[lobelsteve]

"our field continues to attract quick buck artists. Yeah, I stole that from Wall Street." -powermd

Sorry, I missed that. During my business days I was too busy working in the real world to be memorizing cheesy lines from Wall St movies. That stuff is for wannabes. C'mon man. You're a doctor act like it. Quote me studies not movies!

powermd, you are like most doctors. So full of yourself you don't have a clue about the rest of the world. I'm glad I've had the life experiences I've had. Working around doctors I realize what silos some of them are. A lot of them are humble and just do their job. And then there are special guys like yourself that think because they are an MD they know everything about everything.

You have no concept of what it takes to make it in business. Most doctors don't. That's why congress is going to squeeze them. If doctors were like me and demanded proper compensation we wouldn't be in the mess we're in. But that's doctors for you... no business sense.

Please read my earlier posts. Working in real world Wall St is different than movie Wall St. I can't believe someone with post graduate training honestly thinks real life is like the movies! No wonder the rest of the world thinks Americans are idiots. Seriously, did you learn medicine by watching ER?

Look give me some numbers on private practice pain management and leave the business stuff to the experts. As a doctor you have to know your limits.

Despite all that's been said I would still like to hear more about the economics of pain management.

Nothing personal... just business.

You sound like a tool and do not present yourself as one who would do well in pain medicine. Please stay in the OR when you are finished your training. Like most of us on this forum, I will invoke the ignore user function. Sorry I will not see your reply to this post.

 

[drugdealer3000]

.

 

[drugdealer3000]

Look guys,

There are a lot of misconceptions about business and Wall St out there because of pop culture, selective reporting, etc. I can't undo all the misconceptions with a couple of forum post (or a even a ton of forum post). Just trust me there are some downsides.

Its just like I don't tell people I'm a medical student because they make a bunch of erroneous assumptions about what being a doctor is like and I don't want to go through with them what I'm going though on this forum. I try not to bring either topic up.

Please understand.

As far as my ethics are concerned, I would consider myself very ethical. I am very honest. I am honest about what I like and don't like. I'm not going to get on the internet and lie to strangers just to be PC.

And by the way powermd I asked whether one has to do anything unethical to make $1million+ in pain because I want to AVOID unethical situations. I know in your simplistic world you ASSUMED that I want to do something unethical. I can't imagine going through life with such a dark outlook.

I didn't like Wall St because I did not like having the possibility of being put in a position where I had to do something I didn't agree with to make money. I like making $$$ but I don't like compromising my values to do it. If I can do something I'm good at and believe in and that helps people and makes me $$$ I can't understand why people would find that offensive and post symbols everywhere.

There is no point going into a field that is poorly compensated and then complain about the pay for the rest of your life. Find a field where your are happy with the work AND the pay and call it a lifetime. That's my philosophy. Seems logical to me.

 

[roomba]

What kind of doctors are they producing in US medical schools these days?

You've made a few comments about "US medical schools" and "Americans". Are you from the U.S.? If not, did you choose to come to the U.S. for the financial opportunities?

In terms of ethics - what do you consider unethical in the field of pain management? What kind of things do you NOT want to do to make money? Implanting devices in patients who don't really need them? Sticking people without doing a proper physical exam? Sticking people then referring them to other docs to prescribe the opioids?

I think it is possible to make $1 million in pain management - just like in any other field of medicine. Heck you can make $1 million dollars without a pain fellowship in Anesthesia. It really depends on what you are willing to do for the money - whether it be living in an area where no one else wants to live, working hours no one else wants to work, etc.

It sounds from your posts that you are willing to work in an underserved area and work lots of hours. If that's the case then you can definitely make $1 million. The other day, I received a postcard about a pain position in the "midwest" with potential to earn $700K + $200K ancillary income. I dont' know how kosher the practice is... My classmate looked into a similarly lucrative offer and found out it was a mill run by a chiropractor who owned multiple facilities in the region. He didn't want to be associated with that practice and decided the money wasn't worth it. Perhaps it will be to you.

You need to define your "ethics" a little better before we can share various strategies with you.

 

[drugdealer3000]

You've made a few comments about "US medical schools" and "Americans". Are you from the U.S.? If not, did you choose to come to the U.S. for the financial opportunities?

In terms of ethics - what do you consider unethical in the field of pain management? What kind of things do you NOT want to do to make money? Implanting devices in patients who don't really need them? Sticking people without doing a proper physical exam? Sticking people then referring them to other docs to prescribe the opioids?

I think it is possible to make $1 million in pain management - just like in any other field of medicine. Heck you can make $1 million dollars without a pain fellowship in Anesthesia. It really depends on what you are willing to do for the money - whether it be living in an area where no one else wants to live, working hours no one else wants to work, etc.

It sounds from your posts that you are willing to work in an underserved area and work lots of hours. If that's the case then you can definitely make $1 million. The other day, I received a postcard about a pain position in the "midwest" with potential to earn $700K + $200K ancillary income. I dont' know how kosher the practice is... My classmate looked into a similarly lucrative offer and found out it was a mill run by a chiropractor who owned multiple facilities in the region. He didn't want to be associated with that practice and decided the money wasn't worth it. Perhaps it will be to you.

You need to define your "ethics" a little better before we can share various strategies with you.

I'm American. I just have a lot of foreign friends and it gets tiring defending our country given current events and some of the attitudes that some educated people have. Anyway they think I'm over the top because I always call the place the best country in the world.

As far as ethics are concerned I would not do anything to a patient that I wouldn't want done to me. "Do no harm". This just happened to be a salary thread so I wanted to talk about salary. Salary is important, but it isn't the most important thing. I was just as anal with my broker/dealer license. There are ethical guidelines and licensing exams in finance. But you aren't in solo practice. You are a peon in a NYSE listed multinational investment bank with 40,000 employees. You play ball or quit.

The strongest thing I've ever consumed is EtOH. I've never smoked a dubbie or anything like that So I think my opinion of the drug culture and narcotics is pretty clear... despite my forum ID! I mean if someone needs it they should get it, and if they are in pain and dying of cancer I'll give them whatever they need.

As far as implants and injections and so forth I would only do them when medically indicated. Nothing more, nothing less.

Basically a real by the book kind of operation. That's what I'm saying.

I've read a number of posts on here that mention "block shops" and things like that. Its a bit disheartening. I'm glad I'm looking into it now and getting a realistic view of what is going on before I invest a bunch of time in it.

I won't work with or for chiropractors. I would only be willing to use physician extenders in a very limited manner. I don't believe in nurse practitioners, CRNAs, and physicians assistants doing physicians' jobs.

So given everything you've seen with some of these shady outfits do you still feel pain management is worth it for you?

Do you miss the OR? I know some people are glad to be out of the OR and others can't imagine being in an office. I know a couple of pain guys who only do OR work. No pain. Interesting. And then I hear these $1million stories and I wonder where the truth is.

Actually the anesthesia residents I've spoken to seem quite ambivalent about pain. I have never spoken to anyone that loves it. Some people have mentioned doing it to make themselves more marketable and others couldn't imagine forgoing a year or 18 mths salary to do pain. Actually I heard about one attending that liked calling the shots and didn't want to be "subservient" to surgeons. I personally don't need my ego stroked so I could work in the OR no prob. For something that allegedly can rake in $1million a year people seem apathetic. If they open the field to IM they are going to get flooded with apps. Every IM specialty that make $$$ is super competitive. I guess all altruistic IM guys also coincidently happen to like fields that make $$$. Amazing.

 

[WaterAvatar]

when you quote Pain doc salaries... Anesthesia-Pain and PMR-Pain (trained in an anesthesia based program) are equivalent.. right?

 

[Ligament]

when you quote Pain doc salaries... Anesthesia-Pain and PMR-Pain (trained in an anesthesia based program) are equivalent.. right?

In an ideal world and once a pain doc is in practice for a while, then yes. However, straight out of fellowship, I believe the there is still a salary differential, with the anesthesia pain docs getting a higher starting base, even if the PM&R doc did an anesthesia based fellowship at the same program.

PM&R docs trained in a PM&R fellowship that is primarily spine focused (ie. very little cancer pain, sympathetic blocks, stims and pumps) probably get even lower starting offers based on what my friends have been sharing with me that did a PM&R fellowship.

 

[bedrock]

Ligament,
Where do you get your info on the straight out of fellowship salary differences? I can see how some offers might vary for someone who had done a PM&R "spine" fellowship, but I can't see how two different salaries would be offered to two fresh fellowship grads who had both finished the same anesthesia based pain fellowship who differ only in that one of them did a PM&R residency and the other an anesthesia residency prior to the same fellowship.

 

[lobelsteve]

In an ideal world and once a pain doc is in practice for a while, then yes. However, straight out of fellowship, I believe the there is still a salary differential, with the anesthesia pain docs getting a higher starting base, even if the PM&R doc did an anesthesia based fellowship at the same program.

PM&R docs trained in a PM&R fellowship that is primarily spine focused (ie. very little cancer pain, sympathetic blocks, stims and pumps) probably get even lower starting offers based on what my friends have been sharing with me that did a PM&R fellowship.

Firsthand information: Windsor's fellows from last year did better than PM&R, Anes, and the avg Anes-Pain salaries as posted. I won't go into specifics, but I did help review their contracts.

 

[ampaphb]

Ligament,
Where do you get your info on the straight out of fellowship salary differences? I can see how some offers might vary for someone who had done a PM&R "spine" fellowship, but I can't see how two different salaries would be offered to two fresh fellowship grads who had both finished the same anesthesia based pain fellowship who differ only in that one of them did a PM&R residency and the other an anesthesia residency prior to the same fellowship.

Regardless if you can see it or not, them's the facts.

 

[DREZ Leptin]

"but I can't see how two different salaries would be offered to two fresh fellowship grads who had both finished the same anesthesia based pain fellowship who differ only in that one of them did a PM&R residency and the other an anesthesia residency prior to the same fellowship.'

The answer lies in the economic concept of opportunity cost. To be recruited, the anesthesiologist has to be paid more than he can make doing anesthesia. A good anesthesia private practice(I'm in one) is not economically inferior to a pain practice. Not by much,anyway. Plus, no one bothers me after 3 PM unless I'm on call. It all depends on what you want out of life.

 

[Disciple]

However, straight out of fellowship, I believe the there is still a salary differential, with the anesthesia pain docs getting a higher starting base, even if the PM&R doc did an anesthesia based fellowship at the same program.

Would you say this more often occurs in the pain/OR hybird groups? I think it depends somewhat on the practice structure, e.g. with a substantial occ-med pt population, a PM&R may be able to crank out EMGs increasing his/her overall productivity and value to the practice.

PM&R docs trained in a PM&R fellowship that is primarily spine focused (ie. very little cancer pain, sympathetic blocks, stims and pumps) probably get even lower starting offers based on what my friends have been sharing with me that did a PM&R fellowship

My guess is that these fellowships generally lead to employment in a surgical group, and the lower average salary that comes with it.
The other alternative is a PM&R MSK group, which are usually not high volume procedurally, thus lowering the likelihood of a higher base salary.